My brother has struggled his whole life with addiction to alcohol. So did my father (and my father’s mother). It runs in our family. I have to be watchful myself about how much I enjoy alcohol. What I don’t quite understand is why it has such a hold over people who become addicted and why they can’t stay somewhat sober most of the time, especially once they see the devastation it creates in their lives and the lives of all those around them. I’ve been to Al-Anon meetings, of course, but it still doesn’t make sense to me. I hate to see my brother continuously falling off the wagon and returning to drinking, just as my father did when I was younger. My heart goes out to his children because I know how it feels to be in their shoes. I really hate seeing everyone suffering so much. He is a good, well-meaning person. Why can’t he just stay sober? We all feel so helpless in this situation.

Dr. Norquist responds:

It is human nature to seek happiness and to seek relief from life’s problems. Stefan Klein, in his book “The Science of Happiness” (2002) states “addiction is an accident that happens in the course of the human search for happiness.”

Alcohol, or anything that gives us pleasure, for that matter, floods our brains with dopamine, the ‘happiness’ neurotransmitter. Our brain then records this experience as positive and programs it for repetition. Over time, the functioning of large parts of the brain is altered. Dopamine changes the way we react to our environment, enhancing the experience and setting desire and craving into motion. Soon desire takes on a life of its own.

Dopamine levels in the brain double under the influence of alcohol. Through association (the building block of learning) everything linked with alcohol consumption (people, places and things) can trigger the physiological and psychological reaction of desire and craving. In this way, all associations to alcohol have become a part of your brother’s brain structure responsible for positive feelings. Stressful and difficult times lead to an increased desire for the positive, dopamine-enhanced experience of the alcohol. This process applies also to gamblers, compulsive shoppers, sex addicts, etc.

Genetics play a role as well. High tolerance for alcohol puts someone at a higher risk for developing addiction, as does having a brain with too few D2 receptors for dopamine. To make matters worse, addiction further diminishes the number of D2 receptors in the brain even years after becoming sober. As time goes on, the brain habituates to alcohol and the alcohol becomes necessary just to maintain a normal mood. A day without alcohol becomes dull and drab. In this way, alcohol impairs the ability to enjoy life. It has permanently reprogrammed the brain’s system for desire. According to Klein, counteracting this desire is like “unlearning our mother tongue.” Brain cells become pre-disposed to create substances that make the brain especially receptive to any stimuli connected with the craved substance.

This is why people who have been addicted have to work throughout their entire lives to overcome their cravings and learn to resist responding to all the stimuli that have become associated with their addiction. Doing this is a monumental personal achievement for an addict, and one that requires continued watchfulness for the rest of the addict’s life.

(Dr. Sallie Norquist is a licensed psychologist (NJ #2371) in private practice and is director of Chaitanya Counseling Services, a center for upliftment and enlivenment, in Hoboken.) Dr. Norquist and the staff of Chaitanya invite you to write them at Chaitanya Counseling Services, 51 Newark St., Suite 202, Hoboken, NJ 07030 or www.chaitanya.com or by e-mail at drnorquist@chaitanya.com, or by fax at (201) 656-4700. Questions can address various topics, including relationships, life’s stresses, difficulties, mysteries and dilemmas, as well as questions related to managing stress or alternative ways of understanding health-related concerns. 2013 Chaitanya Counseling Services